双能CT虚拟平扫诊断骨质疏松的初步研究  

Dual-energy CT virtual non-contrast technology in the diagnosis of osteoporosis： a preliminary study

作　　者：王林[1] 陈佳佳[2] 龚沈初[1] 顾凯凯[3] 何伯圣[1] 严松强[1] 阮席武[1] 何书[4] Wang Lin;Chen Jiajia;Gong Shenchu;Gu Kaikai;He Bosheng;Yan Songqiang;Ruan Xiwu;He Shu(Department of Radiology, First People＇s Hospital of Nantong City, Nantong 226001, China)

机构地区：[1]南通市第一人民医院影像科,226001 [2]南通市第一人民医院脊柱外科,226001 [3]南通市第一人民医院核医学科,226001 [4]南通大学公共卫生学院统计学教研室

出　　处：《中华放射学杂志》2017年第12期949-953,共5页Chinese Journal of Radiology

摘　　要：目的探讨双能量CT虚拟平扫对骨质疏松（OP）的诊断价值。 方法前瞻性采集2017年2月至2017年3月南通市第一人民医院50例腰部外伤患者的腰椎双能量CT图像，腰1~4中骨折、存在内金属固定物、经皮椎体成形术、肿瘤病变的椎体，及可能影响骨代谢疾病或服用影响骨代谢药物等的患者被排除在外。扫描范围自胸12椎体上缘至骶1椎体下缘，A X线管电压90 kV、B X线管使用锡板滤波器（Sn）150 kV，参考管电流分别为220、138 mAs。采用迭代强度为3的高级模拟迭代重组技术（ADMIRE）进行图像重组，卷积核Qr 40。测量钙的CT值（CM）、混合能量图像的CT值（rCT）、钙浓度（CaD）和脂肪含量百分比（Fat）等参数。采用双能X线吸收法（DXA）测量腰1~4各椎体的骨密度（BMD）和T值。以T值≤2.5个标准差作为诊断OP的金标准，使用Pearson相关分析和线性回归分析比较CT测量结果与椎体骨密度测量结果间的相关性。 结果以椎体为单位进行分析，共有骨质疏松椎体50个，无骨质疏松椎体116个。除Fat外，骨质疏松椎体的各CT测量参数均低于无骨质疏松者，其差异有统计学意义（P均〈0.01）。CM、rCT、CaD与BMD呈显著相关（r依次为0.75、0.65、0.71，P均〈0.01），且为线性关系（F依次为209.91、120.24、167.69，P均〈0.01）；同时，CM、rCT、CaD与T值呈显著相关（r依次为0.74、0.65、0.70，P均〈0.01），且为线性关系（F依次为195.04、120.29、156.37，P均〈0.01）。CM、rCT、CaD与OP诊断金标准的一致率较高（一致率依次为81.9%、62.2%、81.9%），其中CM、CaD的一致率高于rCT，其差异有统计学意义（P均〈0.01）；按CM≤239.5 HU或CaD≤10.9 mg/cm3的标准，其诊断骨质疏松的敏感度分别为86.0%、84.0%，特异度分别为80.2%、81.0%。将CM与CaD进行叠加，叠加后的结果并不能提高对OP的诊断效能（叠加前诊断效能优于叠加后，P�ObjectiveTo investigate the diagnostic value of dual-energy CT virtual non-contrast （VNC） technology for osteoporosis（OP）. MethodsDual-energy CT images of 50 patients with lumbar traumas were collected prospectively. Patients who suffer from vertebral bodies fractures between lumbar 1 to 4, have internal metal fixations or underwent percutaneous vertebroplasty, or presented tumors or compromised bone metabolism induced by diseases or medications were excluded. The scanning range was from the upper edge of the 12th thoracic vertebral body to the lower edge of the first sacral vertebral body. The voltages of tubes A and B were 90 kV and Sn 150 kV, and the reference tubes currents were 220 mAs and 138 mAs. Image reconstruction was performed using Advanced Modeled Iterative Reconstruction （ADMIRE） with iterative strength of 3 and convolution kernel of Qr 40. The default parameters of the virtual non-contrast software were corrected by the standard recommended by the Bone Marrow software of the post-processing platform Syngo.via, and the CT value of calcium （contrast media CM）, the CT value of mixed energy images （regular CT value, rCT）, the calcium density （CaD） and the fat fraction （Fat） were measured. The bone mineral density （BMD） and T score of each lumbar vertebra from lumbar 1 to lumbar 4 were measured by dual energy X-ray absorptiometry （DXA）. With T score less than or equal to the 2.5 standard deviation as the gold standard for the diagnosis of OP, correlations between CT measurements and vertebral BMDs were analyzed using Pearson correlation analysis and linear regression and the diagnostic values of different CT measurements for OP were compared using receiver operating characteristic curve. ResultsEach of the vertebral bodies was analyzed as a single unit. Fifty of them were osteoporotic and the rest 116 were non-osteoporotic. Except for Fat, the CT measurement parameters of the osteoporotic vertebral bodies were lower than those of the ones without osteoporosis, a

关 键 词：骨质疏松 腰椎 双能量CT 虚拟平扫 

分 类 号：R580[医药卫生—内分泌] R816.8[医药卫生—内科学]